Volunteer Application Form

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Please fill out the below form. Please note that we have a 10 week minimum volunteer rotation. Once completed we will have our office contact you as availability opens! Thank you for your interest and we look forward to learning more about you!

CURRENTLY ONLY ACCEPTING AQUATIC THERAPY APPLICANTS.

AQUATIC HOURS: 7:45AM - 11AM WEDNESDAY/FRIDAY AND CLINIC VOLUNTEER HOURS FOR SEPTEMBER 2026.

First Name *

Last Name *

Address *

Phone *

Email *

The volunteer role requires a minimum commitment of one 4-hour shift per week for at least 10 weeks. Are you able to meet this requirement? *

Yes

What discipline are you interested in? *

Occupational Therapy

Physical Therapy

Speech Therapy

Required

Are you currently enrolled in, or previously completed, coursework related to your area of interest (speech, OT, or PT)? *

Yes

What school and year of enrollment are you currently in? If you have already graduated, please write the school and year of completion. *

Why do you want to volunteer at Milestone Pediatric Therapy? *

Do you have experience working with children? *

What do you hope to learn from volunteering at Milestone Pediatric Therapy? *

When do you hope to start and what day would be your last? *

Ideal day(s) and hour(s) for being in the clinic? *

Are you interested in volunteering with our aquatic therapy program on Wednesdays or Fridays, 7:45am to 11am? *

Yes

Please note this is a volunteer position intended for experience only. We are unable to provide letter grades, academic credit, or a formal course evaluation at this time. *

Yes, I acknowledge the parameters of this volunteer opportunity.

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